In the United States, three major health complications are associated with pregnancy; low birth weight, gestational diabetes and maternal pre-eclampsia. Evidence exists to support the benefits of pre-natal care, proper nutrition and regular physical activity as preventative measures to help reduce the risk of all three of the documented health complications(1-3). Although research in the area of exercise and nutrition during pregnancy continues to grow, many gaps in the literature are still apparent including the inclusion of minority populations in research studies. A growing body of literature suggests that healthy and well-nourished women can safely participate in most forms of physical activity during pregnancy (4) but minimal research has been conducted with minority populations. Ironically, many of the minority populations are at increased risk for low birth weight and gestational diabetes. The populations in two Montana counties, Gallatin (home to Bozeman) and Big Horn (home to Crow and part of Northern Cheyenne reservations) are 97% Caucasian and 1% Native American vs. 61% Native American and 36.3% Caucasian, respectively. The low birth weight incidence is 5% and 7% of all births for Gallatin and Big Horn counties, respectively (5). In Montana from 1989-2000, the rate of any diabetes in pregnancy was significantly higher among Indian mothers compared to white mothers both at the beginning of the decade (31/1000 live births in American Indians; 18/1000 live births in whites; p<0.001) and at the end of the decade 41 to 26 per 1,000 live births, respectively. This data indicates that not only is the diabetes incidence greater in Native American mothers as compared to white mothers but also that the incidence of diabetes is increasing in both populations. Overall, 80% of mothers had GDM vs. pre-pregnancy diabetes. Although white Montana mothers have a higher incidence of GDM (80% vs. 71%), Indian mothers had a higher pre-pregnancy diabetes rate (29% vs. 20%)(5). This data demonstrates the apparent health disparities that exist particularly for the Native American population in Montana, yet little research has been done to determine appropriate strategies to engage pregnant women in lifestyle activities that will confer risk reduction. The purpose of this 5 yr project is to document the habits and beliefs regarding nutrition and physical activity in pregnant women living on the Crow reservation. A primary outcome of this project is to develop culturally appropriate nutrition education and physical activity pre-natal programs to reduce gestational diabetes risk. A secondary outcome is to establish a database that allows for the follow-up of these women and their children to assess the relationship between their pregnancy nutrition and physical activity habits and beliefs on future diabetes risk.